To explore literary silence is to explore the relationships between literary texts and the silence of the ineffable. Philosophical and critical accounts tend to operate with a dualistic understanding of silence as the negative other of text. This study, however, seeks to place silence within the literary text. Central to this theoretical endeavour are thinkers like Blanchot, Derrida, Gadamer and Vattimo, and the result is a fundamental challenge to our ideas of silence and text. The study continues to draw on (...) the ideas of Kierkegaard and Bataille to develop an effective methodology for reading such literary silences. (shrink)

Background In the context of limited health care budgets in countries where Neglected Tropical Diseases are endemic, scaling up disease control interventions entails the setting of priorities. However, solutions based solely on cost-effectiveness analyses may lead to biased and insufficiently justified priorities. Objectives The objectives of this paper are to 1) demonstrate how a range of equity concerns can be used to identify feasible priority setting criteria, 2) show how these criteria can be fed into a multi-criteria decision-making matrix, and (...) 3) discuss the conditions under which this decision-making procedure should be carried out in a real-world decision-making context. Methods This paper draws on elements from theories of decision analysis and ethical theories of fair resource allocation. We explore six typical NTD interventions by employing a modified multi-criteria decision analysis model with predefined criteria, drawn from a priority setting guide under development by the WHO. To identify relevant evidence for the six chosen interventions, we searched the PubMed and Cochrane databases. Discussion Our in vitro multi-criteria decision analysis suggested that case management for visceral leishmaniasis should be given a higher priority than mass campaigns to prevent soil-transmitted helminthic infections. This seems to contradict current health care priorities and recommendations in the literature. We also consider procedural conditions that should be met in a contextualised decision-making process and we stress the limitations of this study exercise. Conclusion By exploring how several criteria relevant to the multi-facetted characteristics of NTDs can be taken into account simultaneously, we are able to suggest how improved priority settings among NTDs can be realised. (shrink)

BackgroundIn the context of limited health care budgets in countries where Neglected Tropical Diseases (NTDs) are endemic, scaling up disease control interventions entails the setting of priorities. However, solutions based solely on cost‐effectiveness analyses may lead to biased and insufficiently justified priorities.ObjectivesThe objectives of this paper are to 1) demonstrate how a range of equity concerns can be used to identify feasible priority setting criteria, 2) show how these criteria can be fed into a multi‐criteria decision‐making matrix, and 3) discuss (...) the conditions under which this decision‐making procedure should be carried out in a real‐world decision‐making context.MethodsThis paper draws on elements from theories of decision analysis and ethical theories of fair resource allocation. We explore six typical NTD interventions by employing a modified multi‐criteria decision analysis model with predefined criteria, drawn from a priority setting guide under development by the WHO. To identify relevant evidence for the six chosen interventions, we searched the PubMed and Cochrane databases.DiscussionOur in vitro multi‐criteria decision analysis suggested that case management for visceral leishmaniasis should be given a higher priority than mass campaigns to prevent soil‐transmitted helminthic infections. This seems to contradict current health care priorities and recommendations in the literature. We also consider procedural conditions that should be met in a contextualised decision‐making process and we stress the limitations of this study exercise.ConclusionBy exploring how several criteria relevant to the multi‐facetted characteristics of NTDs can be taken into account simultaneously, we are able to suggest how improved priority settings among NTDs can be realised. (shrink)

Background and objectives: Summary measures of overall health inequality are independent of group membership and enable international comparisons of distribution of health. We compare inequality between and within countries over time and identify normative issues underlying such comparisons. Methods: We used a set of modeled historical life tables for 193 World Health Organization member states from the years 1990, 2000 and 2008 and calculated inequality in age at death and inequality-adjusted life expectancy. Results: Our calculations suggest that overall health inequalities (...) in age at death have been decreasing in the period 1990–2008 in most countries of the world. Only 20 countries experienced increasing distribution in age at death. Simultaneously, overall life expectancy has increased in 85 per cent of all countries. Thus, the combined measure IALE has improved globally. The same overall trend of reduced health inequality applies to all groups of countries stratified by income level. Conclusion: Overall health inequalities, in addition to average health outcomes, could be reported regularly to monitor the health status of populations and the performance of health systems. We find, on normative grounds, the combined measure IALE to be preferable to measuring trends in inequality only. Likewise, we find the Absolute GiniH to be preferable to Relative GiniH. (shrink)

ABSTRACTThe ability to evaluate scientific claims and evidence is an important aspect of scientific literacy and requires various epistemic competences. Readers spontaneously validate presented information against their knowledge and beliefs but differ in their ability to strategically evaluate the soundness of informal arguments. The present research investigated how students of psychology, compared to scientists working in psychology, evaluate informal arguments. Using a think-aloud procedure, we identified the specific strategies students and scientists apply when judging the plausibility of arguments and classifying (...) common argumentation fallacies. Results indicate that students, compared to scientists, have difficulties forming these judgements and base them on intuition and opinion rather than the internal consistency of arguments. Our findings are discussed using the mental model theory framework. Although introductory students validate scientific information against their knowledge and beliefs, the.. (shrink)

Phenomenology has been adapted for use in qualitative health research, where it’s often used as a method for conducting interviews and analyzing interview data. But how can phenomenologists study subjects who cannot accurately reflect upon or report their own experiences, for instance, because of a psychiatric or neurological disorder? For conditions like these, qualitative researchers may gain more insight by conducting observational studies in lieu of, or in conjunction with, interviews. In this article, we introduce a phenomenological approach to conducting (...) this kind of observational research. The approach relies on conceptual grounding to focus a study on specific aspects of the participants’ experiences. Moreover, the approach maintains the openness to novel discoveries that qualitative research requires while also providing a structured framework for data collection and analysis. To illustrate its practical application, we use examples of hemispatial neglect—a neurologic disorder in which patients characteristically lack awareness of their own illness and bodily capacities. However, the approach that we describe can be applied more broadly to the study of complex illness experiences and other experiential alterations. (shrink)

Launched in 2007, the American Medical Students Association PharmFree Scorecard is an annual ranking of conflict of interest policies at American medical centres; it focuses on COIs that may occur when medical education seems likely to be influenced by university-industry relationships, especially those with the pharmaceutical and medical device industries. The PharmFree Scorecard has proven influential in stimulating changes in policy regarding the management of COI at American medical institutions, thus it provides a useful jumping off point for reflection on (...) how and why medical education institutions in other countries – and for our purposes, Canada – should pay more attention to the appropriate identification and management of COI. The PharmFree Scorecard methodology examines a diversity of factors and interests that could influence medical education; as such, it is an interesting approach to analysing the COI policies of medical schools. To test its utility or applicability outside the US, we decided to apply the PharmFree Scorecard to the COI policies of the 16 Canadian universities hosting medical schools. Overall, Canadian institutions rank very poorly, especially in ensuring that education and training tools are provided to staff, students and faculty members to enable the identification and management of COI. However, differences between the US and Canadian medical education contexts, e.g., with regards to the governance and funding of universities, limit to some extent the direct applicability of the AMSA ranking. Canadian medical schools – and their host universities – nonetheless have much to learn from insights provided by the AMSA PharmFree Scorecard ranking, although they can and should go further in developing their own COI policies and procedures. (shrink)

Collaboration for nursing is a core competence and therefore educational interventions are essentials for collaborative skills. To identify such interventions, we carried out a study to understand nursing students' collaborative process. A narrative inquiry method was used to explore the collaborative process of first‐year undergraduate nursing students. The analysis was conducted on field notes from 70 h of observation of 87 nursing students' collaboration during skills lab activities. It also included transcriptions of four focus group discussions with 11 students. The (...) results are presented as a sequential process of (1) navigating in unfamiliar territory, (2) navigating together to cope, and (3) navigating together towards independency and the future nursing profession. We identified a transition from teacher‐led assistance and guidance to student interdependency and reciprocal learning, ending with student‐led assistance supporting independency. In line with Vygotsky's theory of zone of proximal development, different scaffolding interventions are needed depending on where the students are in the collaborative process. (shrink)

The implicit activities of the living body in sports (such as heart rate, involuntary gestures, stress, reflex, emotional regulation and interaction expressions) emerge in the consciousness of the lived body without our voluntary control. We demonstrate physiological emersion, and how, including in dramaturgical perception, physiological flows and processes collide with the image of a whole body. In this paper, we introduce corporeal non-property as the missing (?) link between phenomenology and neuroscience, renewed by research on the cerebral unconscious and the (...) perception of their lived body. Rather than mindfulness, physical activity obliges the subject to learn the unconscious and his motor skills from his living body: a new psychoanalysis of sport is thus established by studying what emerges from the activity of the living body up to the level of the conscious description of motor action. In this paper, we explain why that awareness occurs, and why it matters for the understanding of unconscious activity of the athlete’s living body. This is potentially interesting, although it needs, as a theory, to overcome the obvious reliance of the body on unconscious or habitual/automated physiological processes. But the incorporation of body techniques forms a habitus. (shrink)

Recent studies have shown that schizophrenia may be a disease affecting the states of consciousness. The present study is aimed at investigating metamemory, i.e., the knowledge about one's own memory capabilities, in patients with schizophrenia. The accuracy of the Confidence level (CL) in the correctness of the answers provided during a recall phase, and the predictability of the Feeling of Knowing (FOK) when recall fails were measured using a task consisting of general information questions and assessing semantic memory. Nineteen outpatients (...) were paired with 19 control subjects with respect to age, sex, and education. Results showed that patients with schizophrenia exhibited an impaired semantic memory. CL ratings as well as CL and FOK accuracy were not significantly different in the schizophrenic and the control groups. However, FOK ratings were significantly reduced for the patient group, and discordant FOK judgments were also observed more frequently. Such results suggest that FOK judgments are impaired in patients with schizophrenia, which confirms that schizophrenia is an illness characterized by an impaired conscious awareness of one's own knowledge. (shrink)

C’est à partir de deux exemples concrets, celui des employés de banque et des chauffeurs de taxi collectif à Beyrouth que nous nous proposons d’interroger l’« absence » de la question du temps de travail dans les revendications sociales au Liban. Une absence qui serait l’indice de la prégnance d’un autre rapport au temps : on serait en présence de régimes de temporalités hétérogènes les uns aux autres, à la mesure de la fragmentation de la société entre des mondes sociaux (...) où le travail est soumis à des contraintes radicalement opposées. (shrink)

C’est à partir de deux exemples concrets, celui des employés de banque et des chauffeurs de taxi collectif à Beyrouth que nous nous proposons d’interroger l’« absence » de la question du temps de travail dans les revendications sociales au Liban. Une absence qui serait l’indice de la prégnance d’un autre rapport au temps : on serait en présence de régimes de temporalités hétérogènes les uns aux autres, à la mesure de la fragmentation de la société entre des mondes sociaux (...) où le travail est soumis à des contraintes radicalement opposées. (shrink)

Research on research ethics—regarding both the governance and practice of the ethical review of human subjects research—has a tumultuous history in North America and Europe. Much of the academic literature focuses on issues to do with regulating the conduct and quality of ethics review of research protocols by ethics committees (research ethics boards (REBs) in Canada and institutional review boards (IRBs) in the United States). In addition, some of the literature attends to issues particular to the review of qualitative research, (...) and still other literature addresses the challenges posed by and the need for research on REBs/IRBs. It is this third group of literature within which our article is situated. (shrink)

Subjective reports and theories about memory may have an influence on other beliefs and behaviours. Patients with schizophrenia suffer a wide range of deficits affecting their awareness of daily life, including memory. With the Metamemory Inventory in Adulthood we ascertained patients’ memory knowledge and thoughts about their own cognitive capacities and about several aspects of cognitive functioning: personal capacities, knowledge of processes, use of strategies, perceived change with ageing, anxiety, motivation and mastery. The participants’ ratings were correlated with their intellectual, (...) cognitive and psychiatric data. Patients felt they had a lower capacity and marginally lower mastery over their memory than comparison subjects. They reported less recourse to strategies, and higher levels of memory-related anxiety. However, their knowledge of basic memory processes, motivation to succeed, and perception of ageing effects were similar. So patients with schizophrenia do not suffer a general and non specific impairment of their metacognitive knowledge. (shrink)

Packed with ideas designed to help children learn to sing, this booklet offers criteria for selecting songs, strategies to bring out the best in children's voices, and suggestions for games, ideas, and resources.

Easeful Death sets out straightforwardly the arguments for and against the legalization of assisted suicide and euthanasia. Exploring the philosophical and legal debates as well as the medical practicalities of this sensitive issue, the authors ultimately conclude that the law should embrace a more compassionate approach to assisted dying.

The patient’s home is a common setting for palliative care. This means that we need to understand current palliative care philosophy and how its goals can be realized in home‐care nursing encounters (HCNEs) between the nurse, patient and patient’s relatives. The existing research on this topic describes both a negative and a positive perspective. There has, however, been a reliance on interview and descriptive methods in this context. The aim of this study was to explore planned HCNEs in palliative care. (...) The design was a multiple case study based on observations. The analysis includes a descriptive and an explanation building phase. The results show that planned palliative HCNEs can be described as a process of co‐creating possibilities for the patient to reach vital goals through shared knowledge in a warm and caring atmosphere, based on good caring relations. However, in some HCNEs, co‐creation did not occur: Wishes and needs were discouraged or made impossible and vital goals were not reached for the patients or their relatives. Further research is needed to understand why. The co‐creative process presented in this article can be seen as a concretization of the palliative care ideal of working with a person‐centered approach. (shrink)

TOT states may be viewed as a temporary and reversible microamnesia. We investigated the effects of lorazepam on TOT states in response to general knowledge questions. The lorazepam participants produced more commission errors and more TOTs following commission errors than the placebo participants . The resolution of the TOTs was unimpaired by the drug. Neither feeling-of-knowing accuracy nor recognition were affected by lorazepam. The higher level of incorrect recalls produced by lorazepam participants may be due to the fact that they (...) were more frequently temporarily unable to access a known item. For some of these items, the awareness of the retrieval failure resulted in a commission TOT . The resolution of the TOT conflict is discussed in the light of the anxiolytic and anticonflict effects of lorazepam. The data are discussed in terms of contemporary theories of TOTs and the effects that benzodiazepines have on semantic memory. (shrink)

Targeted transitions in chromatin states at thousands of genes are essential drivers of eukaryotic development. Therefore, understanding the in vivo dynamics of epigenetic regulators is crucial for deciphering the mechanisms underpinning cell fate decisions. This review illustrates how, in addition to its cell memory function, the Polycomb group of transcriptional regulators orchestrates temporal, cell and tissue‐specific expression of master genes during development. These highly sophisticated developmental transitions are dependent on the context‐ and tissue‐specific assembly of the different types of Polycomb (...) Group (PcG) complexes, which regulates their targeting and/or activities on chromatin. Here, an overview is provided of how PcG complexes function at multiple scales to regulate transcription, local chromatin environment, and higher order structures that support normal differentiation and are perturbed in tumorigenesis. (shrink)

To explore literary silence is to explore the relationships between literary texts and the silence of the ineffable. It is to enquire what dynamics texts develop as they strive to 'say the unsayable', and it is to think literature as a silence that speaks itself. This study describes these literary and silent dynamics through readings of Pascal's Pensées, Rousseau's Rêveries, and Beckett's trilogy Molloy, Malone meurt, and L'Innommable. It contributes to our understanding of three major writers and challenges our idea (...) of what silence is. The subject of silence and of the ineffable has a long philosophical and critical tradition. A careful study of this tradition reveals the dominance of a limiting dualistic understanding of silence and its relationship to noise or language: silence becomes the negative other, the beyond, about which there remains nothing to say. The study of literary silence seeks rather to trace a language that becomes its own silence. It compromises the attempt to think a silence that moves within and through texts, that is inherent to the literary expression. Central to this theoretical endeavour are thinkers like Derrida, Deleuze, Gadamer, and Vattimo. The theoretical understanding of silence permits an effective methodology for reading literary silence. Notions of repetition, the aporia and the implosion, which are developed in reference to Kierkegaard and Bataille, describe textual strategies of literary silence and structure the readings. Finally, the reading of literary silence has its point of reference in writers like Mallarmé, Blanchot, and Beckett. It is their texts that have taught us to become topological readers, to move in and out of texts' movements; they have shown us how the literary expression is irreducible to linear, meaning oriented language. As readers of such texts we have been prepared to read the dynamics of the unsayable, and finally to start discerning the silences of the literary. (shrink)

To explore literary silence is to explore the relationships between literary texts and the silence of the ineffable. It is to enquire what dynamics texts develop as they strive to 'say the unsayable', and it is to think literature as a silence that speaks itself. This study describes these literary and silent dynamics through readings of Pascal's Pensées, Rousseau's Rêveries, and Beckett's trilogy Molloy, Malone meurt, and L'Innommable. It contributes to our understanding of three major writers and challenges our idea (...) of what silence is. The subject of silence and of the ineffable has a long philosophical and critical tradition. A careful study of this tradition reveals the dominance of a limiting dualistic understanding of silence and its relationship to noise or language: silence becomes the negative other, the beyond, about which there remains nothing to say. The study of literary silence seeks rather to trace a language that becomes its own silence. It compromises the attempt to think a silence that moves within and through texts, that is inherent to the literary expression. Central to this theoretical endeavour are thinkers like Derrida, Deleuze, Gadamer, and Vattimo. The theoretical understanding of silence permits an effective methodology for reading literary silence. Notions of repetition, the aporia and the implosion, which are developed in reference to Kierkegaard and Bataille, describe textual strategies of literary silence and structure the readings. Finally, the reading of literary silence has its point of reference in writers like Mallarmé, Blanchot, and Beckett. It is their texts that have taught us to become topological readers, to move in and out of texts' movements; they have shown us how the literary expression is irreducible to linear, meaning oriented language. As readers of such texts we have been prepared to read the dynamics of the unsayable, and finally to start discerning the silences of the literary. (shrink)

Cross-border reproductive care (CBRC) can be defined as the movement from one jurisdiction to another for medically assisted reproduction (MAR). CBRC raises many ethical concerns that have been addressed extensively. However, the conclusions are still based on scarce evidence even considering the global scale of CBRC. Empirical ethics appears as a way to foster this ethical reflection on CBRC while attuning it with the experiences of its main actors. To better understand the ‘in and out’ situation of CBRC in Canada, (...) we conducted an ethnographic study taking a ‘critically applied ethics’ approach. This article presents a part of the findings of this research, obtained by data triangulation from qualitative analysis of pertinent literature, participant observation in two Canadian fertility clinics and 40 semidirected interviews. Based on participants’ perceptions, four themes emerged: (1) inconsistencies of the Canadian legal framework; (2) autonomy and the necessity to resort to CBRC; (3) safety and the management of CBRC individual risks; and (4) justice and solidarity. The interaction between these four themes highlights the problematic of ‘reproductive outsourcing’ that characterised the Canadian situation, a system where the controversial aspects of MAR are knowingly pushed outside the borders. (shrink)

Derrida and the Future of the Liberal Arts highlights the Derridean assertion that the university must exist 'without condition' - as a bastion of intellectual freedom and oppositional activity whose job it is to question mainstream society. Derrida argued that only if the life of the mind is kept free from excessive corporate influence and political control can we be certain that the basic tenets of democracy are being respected within the very societies that claim to defend democratic principles. This (...) collection contains eleven essays drawn from international scholars working in both the humanities and social sciences, and makes a well-grounded and comprehensive case for the importance of Derridean thought within the liberal arts today. Written by specialists in the fields of philosophy, literature, history, sociology, geography, political science, animal studies, and gender studies, each essay traces deconstruction's contribution to their discipline, explaining how it helps keep alive the 'unconditional', contrapuntal mission of the university. The book offers a forceful and persuasive corrective to the current assault on the liberal arts. (shrink)

Si en droit public comme en droit privé, l’ordre public limite la liberté contractuelle et fonde des atteintes à la stabilité des relations contractuelles, sa force impérative apparaît aujourd’hui tempérée par la sécurité juridique et par les exigences du service public. Mais il s’agit en réalité de la confrontation de plusieurs éléments de l’ordre public, en raison de la place croissante accordée dans l’ordre social à des valeurs liées à l’institutionnalisation de la paix sociale.

L’article se propose d’explorer l’univers des facultés de droit sous la République de Weimar, que les contemporains jugent en « crise ». Cette perception renvoie tout d’abord aux difficultés d’adaptation d’un enseignement qui est de plus en plus écartelé entre les exigences de la science (transmettre une compréhension historique de l’évolution du droit) et celles de la pratique (préparer les étudiants au monde professionnel par une connaissance du droit en vigueur) : l’Université apparaît ainsi comme un lieu de confrontation entre (...) professeurs et autorités étatiques pour le contrôle du cursus juridique. Par ailleurs, dans un contexte de grande expansion des effectifs étudiants, les facultés de droit ne connaissent pas de démocratisation de leur public et restent le domaine des élites traditionnelles ; de ce fait, elles semblent en décalage avec leur époque et continuent de former un univers passéiste que conforte l’engagement des étudiants dans des corporations traditionnelles. Ce mode de socialisation explique leur radicalisation dans le camp antirépublicain dès les années 1920. (shrink)

For living beings, information is as fundamental as matter or energy. In this paper we show: a) inadequacies of quantitative theories of information, b) how a qualitative analysis leads to a classification of information systems and to a modelling of intercellular communication.From a quantitative point of view, the application in biology of information theories borrowed from communication techniques proved to be disappointing. These theories ignore deliberately the significance of messages, and do not give any definition of information. They refer to (...) quantities, based upon arbitrarily defined probabilistic events. Probability is subjective. The receiver of the message needs to have meta-knowledge of the events. The quantity of information depends on language, coding, and arbitrary definition of disorder. The suggested objectivity is fallacious. (shrink)

A new approach to information is proposed with the intention of providing a conceptual tool adapted to biology, including a semantic value.Information involves a material support as well as a significance, adapted to the cognitive domain of the receiver and/or the transmitter. A message does not carry any information, only data. The receiver makes an identification by a procedure of recognition of the forms, which activate previously learned significance. This treatment leads to a new significance (or new knowledge).

Neuroenhancement involves the use of neurotechnologies to improve cognitive, affective or behavioural functioning, where these are not judged to be clinically impaired. Questions about enhancement have become one of the key topics of neuroethics over the past decade. The current study draws on in-depth public engagement activities in ten European countries giving a bottom-up perspective on the ethics and desirability of enhancement. This informed the design of an online contrastive vignette experiment that was administered to representative samples of 1000 respondents (...) in the ten countries and the United States. The experiment investigated how the gender of the protagonist, his or her level of performance, the efficacy of the enhancer and the mode of enhancement affected support for neuroenhancement in both educational and employment contexts. Of these, higher efficacy and lower performance were found to increase willingness to support enhancement. A series of commonly articulated claims about the individual and societal dimensions of neuroenhancement were derived from the public engagement activities. Underlying these claims, multivariate analysis identified two social values. The Societal/Protective highlights counter normative consequences and opposes the use enhancers. The Individual/Proactionary highlights opportunities and supports use. For most respondents these values are not mutually exclusive. This suggests that for many neuroenhancement is viewed simultaneously as a source of both promise and concern. (shrink)

BackgroundDementia care is essential to promote the well-being of patients but remains a difficult task prone to ethical issues. These issues include questions like whether manipulating a person with dementia is ethically permissible if it promotes her best interest or how to engage with a person who is unwilling to recognize that she has dementia. To help people living with dementia and their carers manage ethical issues in dementia care, we developed the CARE intervention. This is an intervention focused on (...) promoting the ethical self-efficacy of people living with dementia and carers, i.e., their confidence that they can manage ethical issues when they occur. The purpose of this paper is to explain and discuss how we have developed the CARE intervention to promote the ethical self-efficacy of people living with dementia, their family, and professional carers through a specific and, we believe, new use of literary texts.MethodsThe CARE intervention has been developed in two phases: First, we conducted a needs assessment of the occurrence of ethical issues in dementia care and the need for an intervention to support people living with dementia and their carers in managing such issues. Second, in a design phase, we developed the CARE intervention to meet identified needs.ResultsTo address identified ethical issues in dementia care we designed the CARE intervention as a workshop format where people living with dementia and carers can meet, discuss literary texts, and deliberate on how to solve such issues. The workshop is structured by the following elements: An agenda of ethical issues, a collection of literary cases exemplifying ethical issues, a moderator with an understanding of dementia care, and an overview of the ethical principles relevant to the discussion of ethical issues. >This workshop concept is operationalized in three applications tailored to meet the specific ethical issues of each of the study´s three target groups: people living with dementia and family carers, professional and family carers, and professional carers.ConclusionWe conclude the paper by stating that it is possible to develop an intervention that promotes the ethical self-efficacy of people living with dementia and family and professional carers. (shrink)